Rhode Island
Rhode Island requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. The state maintains moratoria prohibiting construction of new nursing facilities or increasing beds at existing nursing facilities. See R.I. Gen. Laws § 23-17-44. The moratoria are currently set to expire on July 1, 2022. Rhode Island further maintains catch-all CONs. Catch-all CONs apply if no other specific CON applies. In that case, the catch-all CON requires healthcare facilities to obtain CONs for projects that will exceed a certain expenditure limit, which is adjusted on an annual basis.
Rhode Island’s COVID-19 Response
On April 10, 2020, Governor Raimondo suspended CON requirements for hospitals and nursing homes and suspended the moratorium on nursing facility beds to allow providers flexibility to respond to COVID-19 as needed. Exec. Order 20-21 (Apr. 10, 2020).66 This order was originally set to expire on May 8, 2020, but was later extended through June 7, 2020, Exec. Order 20-33 (May 8, 2020),67 and was extended again on June 4, 2020, for expiration July 4, 2020. Exec. Order 20-42 (June 4, 2020).
Application Process
In Rhode Island, the CON application process takes 120 days. 216 R.I. Code R. § 40-10-22.10(K)(1). Applications are only accepted twice each year, on January 10 or June 10, 216 R.I. Code R. § 40-10-22.10(C)(3). The fee for a CON application is $500 for regular review or $10,000 for new or expanded tertiary or specialty care services, plus an amount equal to 0.25% of the total capital expenditure costs. R.I. Gen. Laws § 23-15-10. Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. R.I. Gen. Laws § 23-15-6(b)(5).
Types of CONs in Rhode Island
| CON? | CON applies with expenditure of: | Temporary COVID-19 response: | |
| Hospital Beds | Yes | Any amount | Suspended |
| Beds Outside Hospitals | Yes | Any amount | Suspended |
| Equipment | Yes | $2,542,234+ | Suspended |
| Facilities/Buildings | Yes | $5,932,090+ | – |
| Services | Yes | $1,694,883+ | Suspended |
| Emergency Medical Transport | No | - | – |
Rhode Island CONs in Detail
| Category | Moratoria/Types of CONs | 216 R.I. Code R. |
| Hospital Beds An increase in bed capacity that increases the total number of beds or the redistribution or relocation of beds from one physical place to another by ten beds or 10%, whichever is less, in any two-year period. 216 R.I. Code R. § 40-10-22.2(A)(20)(c) | Hospital beds. | § 40-10-22.2(A)(20)(f) |
| Beds Outside Hospitals An increase in bed capacity that increases the total number of beds or the redistribution or relocation of beds from one physical place to another by ten beds or 10%, whichever is less, in any two-year period. 216 R.I. Code R. § 40-10-22.2(A)(20)(c) | Moratorium through July 1, 2022 on increasing bed capacity of any nursing facility to greater than the level of the facility’s bed capacity as of August 21, 1996, plus the greater of ten beds or ten percent. | R.I. Gen. Laws § 23-17-44 (b) |
| Obstetrics beds. Pediatric beds. Medical beds. Surgical beds. Intensive coronary beds. Special care beds. Post-acute care beds. Skilled nursing beds. Intermediate care beds. Rehabilitative care beds. | § 40-10-22.2(A)(20)(c) | |
| Hospice beds. Inpatient rehabilitation center beds. Surgi-center beds. Multi-practice physician ambulatory surgery center beds. Multi-practice podiatry ambulatory surgery center beds. | § 40-10-22.2(A)(12) | |
| Equipment | Positron emission tomography. Linear accelerators. | §§ 40-10-22.2(A)(20)(i), 40-10-22.2(A)(33) |
| Category | Moratoria/Types of CONs | 216 R.I. Code R. |
| Equipment | Full body magnetic resonance imaging. Computerized axial tomography. Cardiac catheterization services | §§ 40-10-22.2(A)(20)(i), 40-10-22.2(A)(33) |
| Any piece of medical equipment costing more than $2,542,234 as adjusted annually. | §§ 40-10-22.2(A)(20)(i), 40-10-22.2(A)(19) | |
| Facilities/Buildings “A certificate of need is required as a precondition to licensure of any new health care facility . . .” 216 R.I. Code R. § 40-10-22.4(F) | Moratorium through July 1, 2022 on opening any new nursing facility. | 23 R.I. Gen. Laws § 23-17-44(a) |
| Construction or establishment of one of the following: Hospitals. Nursing facilities. Inpatient rehabilitation centers. Surgi-centers. Multi-practice physician ambulatory surgery centers. Multi-practice podiatry ambulatory surgery centers. Inpatient hospice care. | § 40-10-22.2(A)(12) | |
| Any capital expenditure by or on behalf of an existing facility in excess of $5,932,090 as adjusted annually. | § 40-10-22.2(A)(20)(b) | |
| Services “No person may incur an obligation for a capital expenditure for a new institutional health service or new health care equipment without obtaining approval for the capital expenditure.” 216 R.I. Code R.§ 40-10-22.4(E) “New institutional health services” includes tertiary or specialty care services. 216 R.I. Code R. § 40-10-22.2(A)(20)(d)(i) | Establishment of one of the following services: Open heart surgery. Organ transplantation. Neonatal intensive care services. Home care providers. Home nursing care providers. | § 40-10-22.2(A)(33) |
| Hospice providers. | § 40-10-22.2(A)(12) | |
| Any health service not offered on a regular basis by a facility within the preceding 12 months that exceeds $1,694,883, adjusted annually, in annualized operating costs. | § 40-10-22.2(A)(20)(h) | |
| Emergency Medical Transport | No CONs in this category. |
Rhode Island CON Exceptions
| No CON Required For: | Citation |
| Any provider of hospice care who provides such hospice care without charge. | 216 R.I. Code R. § 40-10-22.4(G) |
| Acquisition of full body magnetic resonance imaging and computerized axial tomography $1 million on or before January 1, 2010 and was in operation on or before July 1, 2010. | 216 R.I. Code R. § 40-10-22.2(A)(33) |
| Domestic medical tourism. | R.I. Gen. Laws § 23-93-2 |
| Multi-practice facilities. | R.I. Gen. Laws § 23-93-3 |
| Non-clinical capital expenditures. | R.I. Gen. Laws § 23-15-4.1 |
| Research. | R.I. Gen. Laws § 23-15-4.2 |
| Voter approved capital bonds authorizing capital expenditures for state health care facilities. | R.I. Gen. Laws § 23-15-4.4 |
| Single-practice physician or podiatry ambulatory surgical centers. | 216 R.I. Code R. § 40-10-22.2(A)(12) |
| Licensed nursing facility increasing bed capacity not more than 10 beds or 10% of capacity, whichever is greater, if capital expenditure is under $2 million. | 216 R.I. Code R. § 40-10-22.2(A)(20)(g) |
| Acquisitions of existing health care facility that does not result in a change in the service or bed capacity. | 216 R.I. Code R. § 40-10-22.2(A)(20)(b) |
| One-to-one equipment replacement. | 216 R.I. Code R. § 40-10-22.4(I) |